Literature Search

Grap, Mary. ,Munro, Cindy. , Hummel, Russel. , Jessica. , Elswick, and Sessler Curtis. 2005. Effect of Backrest Elevation on the Development of Ventilator-Associated Pneumonia. AACN. Retrieved from ajcc. aacnjournals. org on March 3, 2012. Abstract • Background Ventilator-associated pneumonia is a common complication of mechanical ventilation. Backrest position and time spent supine are critical risk factors for aspiration, increasing the risk for pneumonia. Empirical evidence of the effect of backrest positions on the incidence of ventilator-associated pneumonia, especially during mechanical ventilation over time, is limited. Objective To describe the relationship between backrest elevation and development of ventilator-associated pneumonia. • Methods : It is a nonexperimental, longitudinal, descriptive design was used. The Clinical Pulmonary Infection Score was used to determine ventilator-associated pneumonia. Backrest elevation was measured continuously with a transducer system. Data were obtained from laboratory results and medical records from the start of mechanical ventilation up to 7 days. • Results Sixty-six subjects were monitored (276 patient days).

Mean backrest elevation for the entire study period was 21. 7°. Backrest elevations were less than 30° 72% of the time and less than 10° 39% of the time. The mean Clinical Pulmonary Infection Score increased but not significantly, and backrest elevation had no direct effect on mean scores. A model for predicting the Clinical Pulmonary Infection Score at day 4 included baseline score, percentage of time spent at less than 30° on study day 1, and score on the Acute Physiology and Chronic Health Evaluation II, explaining 81% of the variability (F=7. 1, P=. 003). Literature Search 3 • Conclusions Subjects spent the majority of the time at backrest elevations less than 30°. Only the combination of early, low backrest elevation and severity of illness affected the incidence of ventilator-associated pneumonia. Amelia Ross. (2006). The impact of an evidence-based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia. Retrieved from, www. elsevierhealth. com/journals/iccn. on March 2, 2012.

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Abstract BACKGROUND: Despite strong evidence in the literature on the role of oral care in the prevention of ventilator-associated pneumonia (VAP), nurses continue to view oral care as a comfort measure with low priority and utilize foam swabs rather than toothbrushes. Although an evidence-based oral care protocol existed and best-practice oral care tools were available, the VAP rates had not significantly decreased even though nurses reported providing oral care. OBJECTIVES:

The aim of the study was to determine if an evidence-based practice (EBP) educational program would improve the quality of oral care delivered to mechanically ventilated patients; thereby, reducing the VAP rate. RESULTS: Improvement in oral health was demonstrated by a decrease in median scores on the Oral Assessment Guide (pre (11. 0), post (9. 0)). A t-test analysis revealed a statistically significant difference (p=0. 0002). The frequency of oral care documentation also improved as demonstrated by a positive shift to the more frequent timeframes. The VAP rates have decreased by 50% following the EBP education Literature Search 4 ntervention. CONCLUSIONS: The implementation of an EBP educational program focused on patient outcome rather than a task to be performed improved the quality of oral care delivered by the nursing staff. Carolyn L. , Cason, Tracy, Tyner. , Sue, Saunders, Lisa, Broom. , 2007. Nurses Implementation of Guidelines for Ventilator-Associated Pneumonia from the Centers for Disease Control and Prevention. AACN. Retrieved from ajcc. aacnjournals. org on March 1, 2012. Abstract • Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units.

Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. • Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. • Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. • Results Twelve hundred nurses completed the questionnaire.

Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols.

Literature Search5 • Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols. Grap, Mary. ,Munro, Cindy. , Hummel, Russel. , Jessica. Elswick, and Sessler Curtis. 2005. Effect of Backrest Elevation on the Development of Ventilator-Associated Pneumonia. AACN. Retrieved from ajcc. aacnjournals. org on March 3, 2012. Abstract • Background Ventilator-associated pneumonia is a common complication of mechanical ventilation. Backrest position and time spent supine are critical risk factors for aspiration, increasing the risk for pneumonia. Empirical evidence of the effect of backrest positions on the incidence of ventilator-associated pneumonia, especially during mechanical ventilation over time, is limited. Objective To describe the relationship between backrest elevation and development of ventilator-associated pneumonia. • Methods : It is a nonexperimental, longitudinal, descriptive design was used. The Clinical Pulmonary Infection Score was used to determine ventilator-associated pneumonia. Backrest elevation was measured continuously with a transducer system. Data were obtained from laboratory results and medical records from the start of mechanical ventilation up to 7 days. • Results Sixty-six subjects were monitored (276 patient days).

Mean backrest elevation for the entire study period was 21. 7°. Backrest elevations were less than 30° 72% of the time and less than 10° 39% of the time. The mean Clinical Pulmonary Infection Score increased but not significantly, and backrest elevation had no direct effect on mean scores. A model for predicting the Clinical Pulmonary Infection Score at day 4 included baseline score, percentage of time spent at less than 30° on study day 1, and score on the Acute Physiology and Chronic Health Evaluation II, explaining 81% of the variability (F=7. 1, P=. 003). Literature Search 3 • Conclusions Subjects spent the majority of the time at backrest elevations less than 30°. Only the combination of early, low backrest elevation and severity of illness affected the incidence of ventilator-associated pneumonia. Amelia Ross. (2006). The impact of an evidence-based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia. Retrieved from, www. elsevierhealth. com/journals/iccn. on March 2, 2012.

Abstract BACKGROUND: Despite strong evidence in the literature on the role of oral care in the prevention of ventilator-associated pneumonia (VAP), nurses continue to view oral care as a comfort measure with low priority and utilize foam swabs rather than toothbrushes. Although an evidence-based oral care protocol existed and best-practice oral care tools were available, the VAP rates had not significantly decreased even though nurses reported providing oral care. OBJECTIVES:

The aim of the study was to determine if an evidence-based practice (EBP) educational program would improve the quality of oral care delivered to mechanically ventilated patients; thereby, reducing the VAP rate. RESULTS: Improvement in oral health was demonstrated by a decrease in median scores on the Oral Assessment Guide (pre (11. 0), post (9. 0)). A t-test analysis revealed a statistically significant difference (p=0. 0002). The frequency of oral care documentation also improved as demonstrated by a positive shift to the more frequent timeframes. The VAP rates have decreased by 50% following the EBP education Literature Search 4 ntervention. CONCLUSIONS: The implementation of an EBP educational program focused on patient outcome rather than a task to be performed improved the quality of oral care delivered by the nursing staff. Carolyn L. , Cason, Tracy, Tyner. , Sue, Saunders, Lisa, Broom. , 2007. Nurses Implementation of Guidelines for Ventilator-Associated Pneumonia from the Centers for Disease Control and Prevention. AACN. Retrieved from ajcc. aacnjournals. org on March 1, 2012. Abstract • Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units.

Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. • Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. • Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. • Results Twelve hundred nurses completed the questionnaire.

Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols.

Literature Search5 • Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.